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General NPI Number Information
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NPI Number | 1497136022
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Entity Type | Organization
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Legal Business Name | THRIVE FAMILY THERAPY
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 401 ALBERTO WAY STE 1
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City | LOS GATOS
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State | CA
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Zip | 95032-5404
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Country | US
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Telephone | 408-384-9297
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Fax |
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Provider Business Mailing Address
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Address Line | 401 ALBERTO WAY STE 1
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City | LOS GATOS
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State | CA
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Zip | 95032-5404
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Country | US
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Telephone | 408-384-9297
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Fax |
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Authorized Official
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Title or Position | OWNER/LMFT
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Name | ALISHA BOLEY
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Credential | M.A
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Telephone | 408-384-9297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 52447
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License Number State | CA
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